My Top Read of the Month: Do As I Say, Not As I Do”: Clinician Return to Run Criteria, First Run Characteristics, and Running Assessment Analysis After Anterior Cruciate Ligament Reconstruction Compared to the Literature—Insights From an International ACL Rehabilitation Conference. JOSPT Open. 2026.
Butler B, Kotsifaki R, Whiteley R, Palumbo C, Pairot de Fontenay B, Willy RW, King E.
“Do As I Say, Not As I Do”: Clinician Return to Run Criteria, First Run Characteristics, and Running Assessment Analysis After Anterior Cruciate Ligament Reconstruction Compared to the Literature—Insights From an International ACL Rehabilitation Conference. JOSPT Open. 2026.
Disclaimer: This blog post is written to summarise the article in a simple and clinically useful way so i can refer colleagues or patient to the article. ChatGPT was used to help organise my thoughts and generate infographics.
I was particularly pleased to see this paper finally published. Not only because it addresses an important gap in ACL rehabilitation, but also because I had the opportunity to contribute clinical expertise and feedback during the international survey phase of the project, which is acknowledged in the paper.
Are We Really Following the Evidence for Return to Running After ACL Reconstruction?
This study surveyed 177 clinicians from 51 countries attending the Aspetar International ACL Rehabilitation Conference and compared their reported practice against current recommendations in the literature.
International knee documentation committee (IKDC) 64 points
The literature currently suggests that an IKDC score ≥64 may be useful when considering return to running. However, only 16% used the IKDC. More clinicians preferred the ACL-RSI than the IKDC This is interesting because the ACL-RSI assesses psychological readiness, whereas the IKDC captures symptoms, function and knee-related limitations. Psychological readiness matters. But if the goal is to understand whether the knee is tolerating rehabilitation and prepared for increased loading, symptom-based measures probably deserve more attention.
When to run
The literature often cites 12 weeks post-surgery as the earliest point for running progression. In this survey: 29% of clinicians still preferred the 12–14 week timeframe. 25% reported not using time as a criterion at all.
Clinical signs
- Clinicians were largely aligned when it came to basic clinical assessment. Most clinicians wanted:
- Full knee extension
- Minimal pain
- No or trace effusion
- Adequate knee flexion range of motion
Strength assessment
The literature commonly recommends:
≥70% LSI for concentric isokinetic quadriceps strength
≥80% LSI for isometric quadriceps strength
Many clinicians appeared to favour 80% symmetry regardless of testing method. However, strength does not seems to translate into normal loading during running. A patient may achieve acceptable quadriceps symmetry while still displaying substantial biomechanical deficits during gait.
Running assessment
More than half of clinicians reported performing some form of running assessment.
- 58% performed running assessments
- 42% measured spatiotemporal variables such as cadence or stride length
- 18% measured kinematics
- 3% measured kinetics
This is more a reflection of the realities of clinical practice which normally do have have running assessment tools available.
How to start running again after ACLR
The most common return to running approach was:
- 5–10 minutes duration
- 500–1000 metres
- Self-selected pace or approximately 8–10 km/h
- Interval-based running with walking breaks
